AB0091 IMPACT OF COMORBIDITY BURDEN AS SCORED USING THE RHEUMATIC DISEASE COMORBIDITY INDEX (RDCI) ON RESPONSE TO TREATMENT WITH THE FIRST BDMARD AMONG PSORIATIC ARTHRITIS PATIENTS
Authors: R. Nicolau, A. Martins, D. Santos Oliveira, M. Bernardes, L. Costa
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In addition to the impact of Psoriatic Arthritis (PsA) on risk of death and increased morbidity, other factors, such as comorbidity burden (CB), have also an important role<sup>[1]</sup>. Identifying comorbidities and estimating their impact on the disease course are critical to safely and effectively treating a patient with PsA, as these comorbidities have often implications on therapy selection. <h3>Objectives</h3> To measure the impact of CB on PsA patients treated with a first-line Biologic Disease Modifying AntiRheumatic Drug (bDMARD) using the Rheumatic Disease Comorbidity Index (RDCI). <h3>Methods</h3> Retrospective observational cohort-study of patients with diagnosis of PsA, fulfilling the CASPAR criteria and treated with a first bDMARD, using data from the Reuma.pt database. Patients were divided in 2 groups according the RDCI (RDCI=0 and RDCI≥1) for evaluating its role in clinical response and disease activity at baseline and follow up (6 and 12 months). An univariate analysis was performed followed by a multivariate analysis. <h3>Results</h3> A total of 115 patients were included. 53% (n=61) were females, mean age was 47(±10.7) years old and the median disease duration 10.5 years [1.4-44.1]. At baseline, most of patients exhibited a very high or high disease activity (median DAS284V 4.44, ASDAS-CRP 3.98, BASDAI 6.69) and 68% were concomitantly treated with other DMARD and/or corticosteroids. 43% of patients had at least one comorbidity and the median RDCI score was 1.1 [0.0-6.0]. The most frequently reported comorbidities were cardiovascular disorders (37.7%), depression (13.2%) and pulmonary disease (6.1%). When comparing baseline demographic and clinical characteristics of the 2 subgroups, stratified according RDCI score, we found statistically significant differences in age, age at diagnosis, disease duration, BMI and smoking status. RDCI was poorly correlated with CRP (r=0.162, p&lt;0.01), DAS284V (r=0.263, p=0.008), ASDAS CRP (r=0.284, p&lt;0.001) at 12 months. We also found moderate correlations in RDCI with BASFI (r=0.370, p&lt;0.001) and HAQ-DI (r=0.351, p&lt;0.01). Patients with higher RDCI had lower chance to obtain low disease activity (OR 0.69 (95%CI, 0.61–0.79); <i>p</i> &lt; 0.001). EULAR response rate at 12 months was lower in PsA patients with comorbidities (69.7%vs90.5%, p=0.02). <h3>Conclusion</h3> To conclude, our study demonstrates that baseline CB is an independent predictor for insufficient 12 months response to the first bDMARD. This confirmed the hypothesis that comorbidity should be treated to improve the long-term prognosis in PsA patients. <h3>Reference</h3> [1]Cañete,J.D.,Tasende,J.A.P.,Laserna,F.J.R. et al. The Impact of Comorbidity on Patient-Reported Outcomes in Psoriatic Arthritis: A Systematic Literature Review.2020; Rheumatol Ther 7,237–257 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.